Differentiation of duodenal gastrointestinal stromal tumors from hypervascular pancreatic neuroendocrine tumors in the pancreatic head using contrast-enhanced computed tomography
Differentiation of duodenal gastrointestinal stromal tumors from hypervascular pancreatic neuroendocrine tumors in the pancreatic head using contrast-enhanced computed tomography
复制标题
使用对比增强计算机断层扫描鉴别十二指肠胃肠道间质瘤与胰头富血管性胰腺神经内分泌肿瘤
DOI：
10.1007/s00261-018-1803-x
复制
发表时间：
2019-03-01
影响因子：
2.4
通讯作者：
Wang，Zhongqiu
中科院分区：
文献类型：
--
作者：
Ren，Shuai;Chen，Xiao;Wang，Zhongqiu
目的探讨对比增强CT（CE-CT）在鉴别十二指肠胃肠道间质瘤（diabetic gastrointestinal stromal tumor，DIGTs）和胰头神经内分泌肿瘤（pancreatic head neuroendocrine tumor，NETs）中的价值。CT图像分析包括肿瘤大小、形态和对比度增强。接受者操作特征曲线进行，并计算截断值，以确定CT表现具有较高的灵敏度和specificity.ResultsCT成像显示十二指肠GIST与较高的频率肿瘤中心位置接近十二指肠和主要的实体瘤类型相比，胰头NETs（P< 0.05）。十二指肠GIST大于胰头NET（3.3 ± 0.9 cm vs. 2.5 ± 1.1 cm，p= 0.03）。十二指肠GIST动脉期CT值（112.9 ± 17.9HU vs.137.4 ± 32.1HU，p < 0.01）显著低于胰头NET，延迟期CT值（94.3 ± 7.9HU vs.84.9 ± 10.4HU，p < 0.01）显著高于胰头NET。动脉期（30 s）CT值≤ 135 HU诊断十二指肠胃肠道间质瘤的敏感性为76%，特异性为94.1%，准确性为83.3%;延迟期（120 s）CT值≥ 89.5 HU诊断十二指肠胃肠道间质瘤的敏感性为93.3%，特异性为81.8%，结论肿瘤中心位置、大小、质地和对比增强是术前检查中区分十二指肠GIST和富血供胰头NETS的有价值的特征。
PurposeTo determine useful contrast-enhanced computed tomography (CE-CT) features in differentiating duodenal gastrointestinal stromal tumors (duodenal GISTs) from hypervascular pancreatic neuroendocrine tumors in the pancreatic head (pancreatic head NETs).MethodsSeventeen patients with pathologically confirmed duodenal GISTs and 25 with pancreatic NETs underwent preoperative CE-CT. CT image analysis included tumor size, morphology, and contrast enhancement. Receiver operating characteristic curves were performed, and cutoff values were calculated to determine CT findings with high sensitivity and specificity.ResultsCT imaging showed duodenal GISTs with higher frequencies of tumor central location close to the duodenum and a predominantly solid tumor type when compared with pancreatic head NETs (p< 0.05 for both). Duodenal GISTs were larger than pancreatic head NETs (3.3 ± 0.9 cm vs. 2.5 ± 1.1 cm,p= 0.03). Duodenal GISTs had significantly lower CT attenuation values (112.9 ± 17.9HU vs. 137.4 ± 32.1HU,p< 0.01) at the arterial phase and higher CT attenuation values at the delayed phase (94.3 ± 7.9HU vs. 84.9 ± 10.4HU,p< 0.01) when compared with pancreatic head NETs. A CT attenuation value of ≤ 135 HU at the arterial phase (30 s) was 76% sensitive, 94.1% specific, and 83.3% accurate for the diagnosis of duodenal GISTs, while a CT attenuation value of ≥ 89.5 HU at the delayed phase (120 s) was 93.3% sensitive, 81.8% specific, and 76.2% accurate for the diagnosis of duodenal GISTs.ConclusionTumor central location, size, texture, and contrast enhancement are valuable characteristics for the differentiation between duodenal GISTs and hypervascular pancreatic head NETs during preoperative examination.